MSK case manager Mercedes Tolentino-Nacion, RN, works with patients and families to make sure they've got the right care and equipment to continue their recovery after they leave the hospital. As a registered nurse, her medical knowledge and expertise in the needs of cancer patients make her an especially effective advocate for patients dealing with insurance issues.
It’s a common fear among cancer patients and their caregivers: What will happen when we leave the hospital? How will we manage? People look to their doctors and nurses to treat the disease, but there is so much more to confronting cancer.
Enter the case manager — the unsung hero of cancer care. They are the fixers and troubleshooters, making sure patients have the right support throughout their journey. Case managers think about all the things that might never occur to patients and families in the midst of a scary and confusing time.
Tiffany Wright, the family caregiver for her mother, was able to navigate that overwhelming experience thanks to the guidance of their Memorial Sloan Kettering Cancer Center (MSK) case manager. Tiffany’s mom, Dorothy Freeman, age 71, was ready to be discharged from the hospital after treatment for multiple myeloma. But Dorothy’s insurance company denied the request for the rehabilitation facility her doctors said she needed.
“I almost lost it,” Tiffany says. “You’re dealing with a family member who has a sickness and then you’re having to deal with insurance and the doctor. There are so many parts that make it difficult.” Tiffany, an only child living two hours from her parents, felt alone and afraid.
“I didn’t expect to get any help,” she admits. “Then Mercedes showed up.”
Tiffany Wright was very grateful for the case manager’s guidance as her mother, Dorothy, was discharged from the hospital. “Without Mercedes, I don’t know what we would have done,” she says.
Mercedes Tolentino-Nacion, Dorothy’s case manager, is a member of the MSK team that supports patients and their families at the critical stage when a hospitalized patient is ready for discharge and needs more medical services at home or at another facility. Tolentino-Nacion was determined to help Dorothy. “You cannot send a patient home without trying to find a solution,” she says.
Tolentino-Nacion had a game plan for fighting the insurance denial, and she became Tiffany’s quarterback. She oversaw the application packet for the rehab facility and guided Tiffany through the insurance appeal process: “You just try to work around the system as best you can.” Tolentino-Nacion explains.
This time, Dorothy’s request was approved. “It was such a relief,” says Tiffany. “She helped us get my mom into a place she needed to be.” Dorothy is now back home with her husband and doing well with a home health aide and visiting nurse, and able to maintain her independence. “Without Mercedes, I don’t know what we would have done,” says Tiffany. “She went above and beyond to help us.”
MSK Case Managers Are Relentless Patient Advocates
MSK’s case managers oversee the discharge planning for every patient in the hospital. Patients in MSK’s outpatient locations can also request a case manager. They coordinate medical care for patients who will require special services, such as visiting nurses, and medical equipment at home — everything from hospital beds to walkers, wheelchairs, IV medications, and oxygen. They help patients whose doctors recommend skilled nursing care or physical therapy to find a rehab facility or nursing home.
They are there for support throughout the journey — discussing hospice care with patients near the end of life and helping to connect families with the right resources.
Case managers are MSK’s mission control for discharge planning, making sure all the involved parties — health plans, medical providers, the patient, and their family — are kept in the loop and on the same page. “Basically, you’re a problem-solver,” says Tolentino-Nacion. “Maybe a little bit of a bulldog when you need it.”
MSK Case Managers Are Registered Nurses
Some hospitals employ social workers as case managers, but Tolentino-Nacion, like all of MSK’s case managers, is a registered nurse. “We’re a cancer hospital. Our social workers are focused on the psychosocial aspects of a cancer journey,” explains the Director of Case Management, Stephanie Puccia. “Our patients want to know what medical services they can have at home. That’s why we offer nurses to help them.”
Case managers at MSK must have another special skill. They need to be flexible, out-of-the-box thinkers. “You have to be willing to try a whole lot of things and hear a lot of ‘that’s not going to work’ before you come up with the perfect plan that meets your patient’s needs,” says Puccia. “And Mercedes really is a gem. Her heart is in it.”
5 Tips To Stay On Top Of Patients’ Needs At Home
Puccia shares five tips to help ensure a smooth transition for patients leaving the hospital.
It’s never too early to think about care at home.
The MSK case managers’ mantra is “Discharge planning starts on day one.” They advise patients and caregivers to start thinking about discharge planning as soon as you know you’re going to be admitted to the hospital. Contact your insurance company. Ask about your home-care and long-term-care benefits. Your case manager will work with you to see what your insurance will cover and what the other options are to get what you need.
Plan the trip home.
Transportation is so important, and nobody thinks about it until the day they’re getting discharged. Transportation is typically not covered by insurance, especially if you’re mobile when you leave the hospital, meaning you can walk, stand, or sit.
Even if you’re discharged to another facility, your insurance might not cover that transportation, either. If your family or friends can’t take you, your case manager can suggest a car or ambulance service. You will have to pay for this.
Don’t throw away that walker.
If you’re given a walker, a cane, a wheelchair, and it’s yours to keep, hang on to it — even if you don’t think you need it. Most insurance companies will not cover another piece of the same equipment for at least five years. Paying out of pocket for a walker can be more expensive than you think.
Pay attention to the nurse and ask questions.
When your nurse is taking care of you or a loved one, like doing a dressing change or cleaning a wound, pay attention and ask questions as early as possible. Even if we set you up with nursing services to visit you at home, they don’t come every day and won’t stay all day. A lot of that care is going to be your or your caregiver’s responsibility. Use your time in the hospital to start preparing whatever questions you have. Ask your care team to show you how to perform a task and then do it yourself while they watch. We want to make sure to teach you what you’ll need to know at home.
Know the basics of your insurance plan.
Know what your insurance company covers. A lot of people come into the hospital thinking they’re going to get 100% coverage — only to have the case manager break the news that something is not covered.
This is the hardest part of our job. Telling patients that their health plan doesn’t cover what they’re requesting. We can’t answer direct insurance questions. We don’t have that information, but we can tell you how to find out what your plan accepts.
So take a minute and just familiarize yourself with the basics of your health plan. You don’t need to have mastered the specifics. But just know the things that aren’t covered when you come into the hospital, to help us plan your discharge home.
These tips and knowing “how much our caseworker was fighting to help us ” says Tiffany, gave their family hope and strength. Tolentino-Nacion likewise credits Tiffany for always being there for her mother. “She was such a dedicated daughter,” she says. “You just wanted to do more for her. To say, here, let me take a little of the burden off of you.”